Impact Evaluation Note Kenya Names of team members

H E A LT H R E S U LT S I N N O VAT I O N T R U S T F U N D

1. Background

•  Prepilot in 1 sub-county (Nov 2011 – present) •  Scaling up to 21 counties (12 million, 28% of population) •  Arid Semi-Arid Land counties

o  Sparsely populated o  Higher level of poverty o  Poorer health indicators o  Limited resources in the health sector (HRH, infrastructure, government

budget, donor support)

•  Motivation: o  Equity consideration – where support is most needed o  RBF as part of system reform to improve performance

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2. Description of Intervention

•  Supply side RBF •  Pays facilities for delivery of 6 key MNCH indicators •  Program involves both Primary Public and FBO facilities •  Pays for both quantity and quality indicators on quarterly

basis •  60% of facility payment is staff incentive and 40% is for

facility improvement •  Features may be revised in the design of scale up

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3. Results Chain

o  …

INPUTS ACTIVITIES OUTPUTS OUTCOMES LONGER-TERM

OUTCOMES HIGHER ORDER

GOALS

o  … o  … o  … o  …

4. Primary Research Questions

1.  What is the impact of RBF on Service utilization and quality of care for incentivized services

2.  Does explicitly involving CHWs in the program provide better results than default supply side RBF

3.  What factors explain the observed results

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Outcome Measures

6. Identification Strategy/ Method

What is the impact of RBF on Service utilization and quality of care for incentivized services

Difference-in-differences 21 RBF counties vs 21 non-RBF counties

Does explicitly involving CHWs in the program provide better results than default supply side RBF

RCT 50% RBF only vs. 50% RBF+CHWs (at sub-county level – 85 subcounties)

What factors explain the observed results

Qualitative study

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0

10

20

30

40

50

60

70

1 2 3

inst deliveries

Series1 Series2

0

5

10

15

20

25

30

35

40

45

1 2 3

ANC4

Series1 Series2

0 10 20 30 40 50 60 70 80 90

1 2 3

vaccination

Series1 Series2

0

10

20

30

40

50

60

1 2 3

FP

Series1 Series2

Diff-in-diff: 3 year trend in ASAL and non-ASAL counties

7. Sample and Data

1. Surveys •  Facility + household surveys •  Before and after •  Samples from non-RBF, RBF only, RBF + CHWs

2. HMIS data •  all counties except for 5 big and wealthy counties •  3 years before program + duration of program

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8. Time Frame / Work Plan

•  Work plan: •  Form TWG for IE •  Training to sensitize on IE: policy makers, county executive

committee members for health, county health directors and staff

•  Finalize design of intervention and of IE

•  Time frame •  Finalize protocol: mid-May •  Baseline: Sept 2014 •  Endline: Dec 2016 or June 2017

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